FIGHT, PERSIST and LEVOREP

Patients in the latest stages of heart failure are severely compromised, with poor quality of life and frequent hospitalisations. Heart transplantation and left ventricular assist device implantation are viable options only for a minority, and intermittent or continuous infusions of positive inotropes may be needed as a bridge therapy or as a symptomatic approach. In these settings, levosimendan has potential advantages over conventional inotropes, such as sustained effects after initial infusion, synergy with beta-blockers, and no increase in oxygen consumption. Levosimendan has been suggested as a treatment that reduces re-hospitalisation and improves quality of life (see journal article). A panel of 45 expert clinicians from 12 European countries met to review the literature and envision an appropriately designed and properly powered clinical trial addressing these needs. In the earlier FIGHT trial, a composite global rank score was used as primary endpoint where death, re-hospitalization and change in natriuretic peptide level were considered in a hierarchical order. The same endpoint was tested post hoc in the PERSIST and LEVOREP trials, and demonstrated superiority of levosimendan treatment vs placebo. The use of the same composite endpoint in a properly powered study on repetitive levosimendan in advanced heart failure is strongly advocated.

Professor Gerhard Pölzl highlights Hospitalisation for the management of acute decompensation being a critical moment in the trajectory of heart failure (HF) and one that has gloomy prognostic implications for many patients.

There have been some recent achievements in the LEODOR trial including a new website to facilitate administration and communication and submission of a formal study protocol synopsis to the European Journal of Heart Failure.

If we had a way to reduce the risk of life-threatening complications after cardiac surgery would we use it? Of course we would. It is for reason that this blog post highlights the recent work of Dr. Qiang and colleagues. See the details here.

Professor Gerhard Pölzl reports primary results from the LION-HEART study in the management of advanced heart failure where among secondary endpoints, patients treated with levosimendan experienced a reduction in the rate of HF-related hospitalisation compared with placebo.

Professor Cynthia M Dougherty and colleagues outline an array of options for the treatment of advanced heart failure (HF) that create – quite reasonably – the impression that we are in a golden age of therapeutic possibilities for this difficult condition.